Archived Insolence: The Archive site for Respectful Insolence

Who (or what) is Orac?

About Me

Location: The Liberator, somewhere deep in Federation space, United States

Orac is but a humble pseudonymous surgeon/scientist with an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his miscellaneous verbal meanderings, but just barely small enough to admit to himself that few will. That Orac has chosen his pseudonym based on a rather cranky and arrogant computer shaped like a clear box of blinking lights from an old British SF show whose special effects were renowned for their early 1980's BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction for television ever produced, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.) Orac tries to keep his insolence respectful, but admittedly sometimes fails in the cases of obvious quackery and pseudoscience, attacks on him, very poor critical thinking skills, bigotry, and just general plain stupidity.

What is Respectful Insolence?

Respectful Insolence is a repository for the ramblings of the aforementioned pseudonymous surgeon/scientist concerning medicine and quackery, science and pseudoscience, history and pseudohistory, politics, and anything else that interests him (or pushes his buttons). Orac's motto: "A statement of fact cannot be insolent." (OK, maybe it can be just a little bit insolent.)

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Respectful Insolence looks best on Firefox or Safari. Orac is therefore obligated to warn his readers that strange things sometimes happen to the right sidebar when RI is viewed on the inferior browser known as Internet Explorer. Even Orac, with his ability to communicate with any computer in the galaxy, has not yet been able to determine why this happens and therefore curses Microsoft.

Insolent Disclaimer

This is a personal web log, reflecting the sometimes prickly opinions of its author. Statements on this blog do not represent the opinions of anyone other than the author. They most definitely do not represent the opinions or position of the author's hospital, university, surgical practice, or partners. The information on this blog is intended for discussion and entertainment purposes only and not as recommendations on how to diagnose or treat illnesses. Any personal medical issues the reader may have should be referred to the reader's physician. If the reader freely chooses to follow the opinion of a pseudonymous blogger like the author (who has also not done a proper history or physical examination and whose credentials cannot be verified) over that of his or her own personal physician, it is the reader's decision alone, for which the reader must bear full responsibility.

E-mail policy: All e-mail replies to Orac in response to material posted to this blog are subject to being publicly reprinted on Respectful Insolence solely at the discretion of Orac. Requests not to publicly reprint an e-mail will certainly be considered on a case-by-case basis, but Orac offers no guarantee that he will honor them (especially if the e-mail in question is obnoxious, threatening, or insulting).

Tuesday, January 25, 2005

Medicaid crisis in Washington

Dr. Bob, of the excellent blog The Doctor Is In, and I have had our occasional differences, but yesterday he posted something that was right on target, a description of the crisis in access to health care for the poor in Washington brought on by low Medicaid reimbursements. He's right. Medicare reimbursements usually barely cover the cost of providing service or, at best, slightly more, and Medicaid reimbursements usually run between 60-75% of Medicare reimbursement for the same services (depending upon the region of the U.S.). That means that doctors who accept Medicaid patients usually lose money on them. Many still accept them, but it is more a matter of charity and a feeling of obligation. Those who do accept them cannot allow them to become too large a percentage of their patients, or their practice will no longer be financially viable. One advantage of being in academics (as I am) is that I'm shielded somewhat from these forces, mainly by state subsidies to our medical school and hospital. Given the budget crunch facing our state currently, those subsidies are bound to decrease soon, and we will likely be in the same boat our private practice colleagues have been in for a while.

I'd like to add just one thing. In medicine, market forces, for the most part, do not determine charges. In effect, the government determines our rates of reimbursement. Most HMO's, insurance companies, and third-party payors start their negotiations over reimbursement rates for doctors, medical practices, and hospitals at the Medicare rate. Usually, the contracts end up being somewhere around 100-130% of Medicare (although occasionally, particularly hard-nosed insurance companies have managed to negotiate rates below Medicare reimbursement). In addition, Medicare rates are not even keeping up with inflation, and for some procedures they are even being cut. However, expenses keep going up, and malpractice insurance premiums keep going up; but, unlike other professions, doctors have a very hard time raising their rates to cover their increased costs. That may mean that, soon, the crisis in access to care for Medicare patients could spread to those of us who think ourselves safely insured.